Provider Demographics
NPI:1457717928
Name:JOHNSTON, DYANNA (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:DYANNA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 PINE MDW
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-5563
Mailing Address - Country:US
Mailing Address - Phone:707-344-0524
Mailing Address - Fax:
Practice Address - Street 1:1301 SE 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-7307
Practice Address - Country:US
Practice Address - Phone:405-632-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK95313363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner